Provider Demographics
NPI:1063244358
Name:DYER, SHANNON LEE (CSFA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:DYER
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 HENDRIX RD
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3664
Mailing Address - Country:US
Mailing Address - Phone:828-361-5484
Mailing Address - Fax:
Practice Address - Street 1:75 MEDICAL PARK LN STE B
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6673
Practice Address - Country:US
Practice Address - Phone:828-837-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant